Monday, November 06, 2006

ACTION NOW: Putting the Right Emphasis on the Institute of Medicine Report of IDU and HIV

Then following Letter to the Editor appeared in Lancet 4-10 Nov 06: The Lancet Intravenous drug use and HIV

BYLINE: Robert G Newman SECTION: Pg. 1574 Vol. 368 No. 9547 ISSN: 0140-6736

Your Editorial (Sept 30, p 1127) on the recently released report by the US Institute of Medicine (IOM) about intravenous drug use and HIV incorrectly describes methadone and buprenorphine as opioid antagonists; in fact, methadone is a pure agonist and buprenorphine a mixed agonist-antagonist.

What is of more importance, however, is that the body of the Editorial seems to water down the message embodied in the title: "evidence for action now". Thus, you state that "there is some evidence that continuous drug-dependence treatment protects against seroconversion", whereas the IOM clearly and unequivocally concluded: "Strong and consistent evidence from a number of well-designed, randomized controlled trials shows that opioid agonist maintenance treatment-including methadone and buprenorphine-is effective in reducing illicit opioid use... There is also strong evidence that this treatment reduces drug-related risk behavior."

As for the unambiguous recommendations that flow from the IOM's review, they are not consistent with your call for "more robust studies" while nations "devise and implement multicomponent programmes that reflect their specific economic, cultural, and social circumstances." The IOM concludes without mincing words: "We do not end [the report] with 'More research is needed'... We say instead, 'Action is needed.'" Yes, indeed!

I declare that I have no conflict of interest.


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